DKI在鉴别脑胶质瘤复发与假性进展中的应用价值研究  

Application value of DKI in distinguishing recurrence and pseudoprogression of glioma

作　　者：党佩 王立东 黄雪莹[1] 刘静静 吕瑞瑞 杨治花[5] 王晓东[1] DANG Pei;WANG Lidong;HUANG Xueying;LIU Jingjing;LÜ Ruirui;YANG Zhihua;WANG Xiaodong(Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,Yinchuan Traditional Chinese Medicine Hospital,Yinchuan 750001,China;Department of Radiology,Xi'an Chest Hospital,Xi'an 710061,China;Ningxia Medical University School of Clinical Medicine,Yinchuan 750004,China;Department of Radiotherapy,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院放射科,银川750004 [2]银川市中医医院放射科,银川750001 [3]西安市胸科医院放射科,西安710061 [4]宁夏医科大学临床医学院,银川750004 [5]宁夏医科大学总医院放疗科,银川750004

出　　处：《磁共振成像》2022年第5期28-33,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：宁夏回族自治区重点研发计划(编号:2019BEG03037)。

摘　　要：目的探讨扩散峰度成像(diffusional kurtosis imaging,DKI)技术在鉴别脑胶质瘤复发与假性进展中的临床应用价值。材料与方法回顾性分析宁夏医科大学总医院2018年10月至2020年12月间40例术后行放、化疗并行DKI序列扫描的脑胶质瘤患者资料。通过二次手术病理或经增强MRI扫描随访>6个月,分复发组(24例)与假性进展组(16例)。采用独立样本t检验或Mann-Whitney U检验,受试者工作特征曲线比较两组患者增强病灶和瘤周水肿中DKI参数值:平均扩散峰度(mean kurtosis,MK)、平均扩散系数(mean diffusivity,MD)、径向扩散峰度(radial kurtosis,RK)、轴向扩散峰度、各向异性分数。以患者无进展生存期(gression free survival,PFS)作为事件的观察终点,Cox比例风险模型用于多因素分析。结果复发组较假性进展组增强病灶的相对平均扩散峰度(ratio of MK,rMK)、相对径向扩散峰度(ratio of RK,rRK)升高(P<0.05),相对平均扩散系数(ratio of MD,rMD)降低(P<0.05),rMK、rRK、rMD的曲线下面积(area under the curve,AUC)分别0.94、0.83、0.70(P<0.05)。复发组较假性进展组瘤周水肿的rMK升高、rMD降低(P<0.05),rMK、rMD的AUC分别0.82、0.73(P<0.05)。脑室下区受累、增强病灶的rMK、rRK、rMD和瘤周水肿的rMK、rMD均与PFS具有相关性(P<0.05)。结论DKI可用于鉴别胶质瘤复发与假性进展,参数值MK可作为较好的影像学标记,增强病灶的MK值是PFS的独立危险因素。Objective:To investigate the value of DKI technology in differentiating glioma recurrence and pseudoprogression in clinical.Materials and Methods:Retrospectively collect of 40 patients with glioma who underwent surgery,radiotherapy,chemotherapy and DKI scanning from October 2018 to December 2020 in the General Hospital of Ningxia Medical university.Patients was divided into the recurrence group(24 cases) and the pseudoprogression group(16 cases) by pathology or enhanced MRI scan followed up for more than 6 months.Data were compared by independent samples t-test,Mann-Whitney U-test and receiver operating characteristic to compare the DKI parameter values in enhancing lesions and peritumoral edema in the two groups of patients:Mean kurtosis(MK),mean diffusivity(MD),radial kurtosis(RK),axial kurtosis,fractional anisotropy.Using patient gression free survival(PFS) as the observation end point for events,cox proportional hazards model was used for multivariate analysis.Results:Compared with the pseudoprogressive group,the ratio of MK(r MK) and ratio of RK(r RK) of the enhanced lesions in the recurrence group were increased,and ratio of MD(r MD) was decreased(P<0.05).The AUCs of r MK,r RK,and r MD were 0.94,0.83,and 0.70,respectively(P<0.05).Compared with the pseudoprogressive group,the r MK of peritumoral edema was increased in the recurrence group and r MD was decreased(P<0.05).The area under the ROC curve of r MK and r MD were 0.82,0.73,respectively(P<0.05).Involvement of the subventricular zone,r MK,r RK and r MD in enhanced lesions and r MK,r MD in peritumoral edema were correlated with PFS(P<0.05).Conclusions:DKI can be used to distinguish recurrence and pseudoprogression of glioma,and the parameter value MK can be used as a better imaging marker,the MK value of enhancing lesions is an independent risk factor for PFS.

关 键 词：脑胶质瘤 复发 假性进展 扩散峰度成像 磁共振成像 瘤周水肿 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.264[医药卫生—诊断学]